Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

Do SSRIs Raise PTB Risk? Sep 02, 2024

Show notes

Depressive disorders during pregnancy are common, with estimated prevalence ranging from 11% to 16%. Accordingly, antidepressant drugs, most commonly selective serotonin reuptake inhibitors (SSRI), are used by approximately 3–4% of pregnant women worldwide, with a higher prevalence in the United States compared to Europe. As antidepressants cross the placenta and the fetal blood-brain barrier, exposure during pregnancy raises concerns of potential risks of adverse pregnancy outcomes. On August 30, 2024, a new study was released ahead of print in the AJOG. This confirmed the reduction in preterm birth risk with effective mental health counseling approaches; HOWEVER, it also concluded that “use of antidepressants during pregnancy was associated with an increased 31% risk of pre-delivery independent of underlying depression “. Do SSRI meds increase preterm labor risk by 31%?! This is indirect contrast to a separate publication published just six months earlier, in February 2024 in a separate journal. In this episode, we will discuss this very important topic of SSRI use in pregnancy and the preterm birth risk.

OROPOUCHE! Aug 30, 2024

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Just when we thought we had put coronavirus in our rearview mirror for the most part, here comes mPOX again. We covered that in a previous episode. Unfortunately, that is not the only pathogen to be concerned about. Enter: OROPOUCHE VIRUS (OROV). This virus was first reported in 1955, but it is making news today due to a rapid increase in cases. Coming from the Amazon Basin, and even Cuba, there have been 21 cases in the USA diagnosed in US travelers. This virus is a concern for pregnant women. Information gaps still exist but things are moving quickly here: On August 16, 2024, the Centers for Disease Control and Prevention issued a Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in Oropouche virus (OROV) disease, originating from endemic areas and in new areas in South America and the Caribbean. Then, on August 22, 2024, SMFM released its alert on the virus. Today, the ACOG released its Practice Advisory (August 29, 2024) on this very issue. Listen in for details.

“New” Info on PCOS: Name Change? OB Implications? Aug 29, 2024

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Polycystic ovary syndrome (PCOS) was first described in 1935 by Irving Freiler Stein and Michael Leo Leventhal at the Central Association of Obstetricians and Gynecologists. Since that time, it has gone through several name changes: Stein-Leventhal syndrome, PCOD, and currently PCOS. Nonetheless, proponents and scientists are still recommending yet another name change for this syndrome, one that better incorporates the multi-metabolic dysregulation that it incorporates. PCOS is not simply a gynecological issue. It is a metabolic issue with implications for adverse obstetrical outcomes. In this episode we will review 2 recent publications, one from July 2024 and the other from August 27th, 2024. These two studies, in two separate journals, each a month apart, validate what others have previously reported: PCOS doesn't just affect gynecological health but it also impacts obstetrical health. Listen in for details.

BRAND NEW Lexicon for 1st Trimester US (08/27/24)! Aug 28, 2024

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Our immediate past episode focused on the “C-section scar pregnancy”. In that episode we discussed the ultrasound markers of early pregnancy (first trimester). Now – today – HOT 🔥🔥OFF THE PRESS- is a new publication in the AJOG, which is “A Lexicon For First Trimester US: Society of Radiologists in Ultrasound Consensus Conference Recommendations“. This consensus statement is through a MOU through the ACR, ACOG, AIUM, SMFM, ASRM, SFP, and the ACEP. For the first time, we have a proposed universal lexicon for ultrasound markers in the first trimester. This also discusses the cesarean scar topic pregnancy. Listen in for details!

CS Scar Pregnancy Aug 26, 2024

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Cesarean scar pregnancy (CSP) occurs when an early pregnancy implants on the cesarean scar defect (CSD), myometrial tissue previously disrupted by cesarean delivery. The first case of CSP was reported in 1978 in a patient with a previous cesarean section (CS) who had heavy bleeding and abdominal pain after uterine curettage for a suspected miscarriage at 6 weeks. Eventual laparotomy revealed erosion of a major vessel in the scar sacculus by the products of conception which was successfully obliterated with subsequent revision of the previous surgical site. This was published in the South African Med Journal. Early ultrasound evaluation is crucial for detecting this condition. These are very complicated situations with increased rates of antepartum and postpartum hemorrhage, uterine rupture, PAS, preterm birth, and massive transfusion. Perhaps because of high worldwide cesarean delivery rates, there seems to be increased incidence and recognition of this condition over the past 2 decades. The clinical presentation is variable, and many are asymptomatic at presentation. In this episode, we will review the diagnosis and management of this unique and challenging high-risk pregnancy.

Make it TIGHT! 😳 Aug 24, 2024

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(DISCLOSURE: Sexual Content) Back in April 2023, we released an episode on the “Jade Vaginal Egg” and vaginal weights for vaginal tightening. While we tackled the Jade Egg successfully, we now have a new player on the field: the VAGINAL TIGHTENING STICK. This over the counter “sex aid” can lead to chemical burns and severe vaginal dryness/agglutination. Marketed to improce vaginal laxity, some of these sticks have the real potential to cause tissue damage and scarring- as one of our podcast family members saw firsthand with a patient. Its an interesting market place out there! Listen in for details.

The “Broken” IUD: Detection and Clinical Management Aug 22, 2024

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The IUD is a very safe and supremely effective contraceptive method. Given its increasing rate of use, practitioners are bound to see its relatively infrequent complications with greater regularity. Typical complications are considered “lost strings“, uterine perforation at placement, and expulsion. But there is another complication, device FRACTURE at removal. This can cause distress to the patient and can lead to additional interventions. Fracture of an intrauterine device (IUD) upon removal is a very rare complication, with a prevalence rate of 1–2%. However, the numbers have been rising since 2021, causing the FDA to track these complications. There has even been a bizarre case report of the copper coils being found in the pelvis WITHOUT device fracture! How?? In this episode, we will describe and review this relatively recent issue, its diagnosis, ways to minimize its occurrence at removal, and management strategies.

Umbilical Cord Gases: What, Why, When? Aug 21, 2024

Show notes

In 1958, James et al. first described umbilical cord blood gas analysis to evaluate the fetus's metabolic condition at the time of delivery. It's recommended by both the British and American Colleges of Obstetrics and Gynecology for all high-risk deliveries. Cord blood gas provides the most accurate and objective evidence of fetal acidosis at the time of birth. Still, there is no universal agreement on when to perform umbilical artery gas analysis, or cord gas, for babies. Some suggest that all babies should have their umbilical artery and vein sampled immediately after birth, while others recommend only sending a sample if you think you need one, or in high-risk pregnancies. Should we collect umbilical cord gases universally- in all deliveries? And what about umbilical cord lactate levels? Is that helpful in predicting adverse newborn outcomes? Listen in for details.

FDA HPV Self-Swab Ready Aug 15, '24: NOT FOR HOME (Listen for Details) Aug 18, 2024

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According to the National Institutes of Health, almost 13,000 women in the United States are diagnosed with cervical cancer each year, resulting in around 4,000 deaths, with most of the deaths occurring among under-screened women. Now, there is potentially a barrier-breaker. As of August 15, 2024, self-collection kits for cervical cancer screening may be available in doctor's offices and other clinical sites, ready for use. The kits allow patients to collect their own vaginal sample for HPV testing in a health care setting, as an alternative to a Pap smear. The FDA approved the kits on May 15, 2024. This is different from the OTC at-home HPV test kits. The tests, which are FDA cleared, are not yet available for people to use at home. The FDA's approval of these tests aims to increase access to HPV screening and reduce barriers to sample collection. Roche and BD both plan to consider offering at-home options in the future. Although a variety of companies currently offer at-home HPV tests, the Food and Drug Administration (FDA) has not yet approved at-home HPV tests. Listen in to today’s episode for details.

NEW Syphilis At-Home Test: Promises and Problems Aug 18, 2024

Show notes

The rise of home testing for STIs/HIV started long before the recent pandemic (the FDA approved its first HIV home test collection kit way back in 1996), but COVID-19 seems to have accelerated the popularity of getting tested from the comfort of our homes. In Nov 2023, the Food and Drug Administration granted marketing authorization, the first of its kind, for an at-home test for chlamydia and gonorrhea. The test kit, called Simple 2, is available online through various offerings. Chlamydia and gonorrhea are the most common STIs in the U.S. Of course, syphilis has also been on the move. And now, as of August 2024, The FDA has granted new clearance to NOWDiagnostics (not a sponsor) for the first at-home, over-the-counter syphilis screening test. So now we have gonorrhea, chlamydia, and syphilis at home testing options. At home HPV swabs are also seeking entrance into the marketplace. While these options remove barriers to care and allow testing in the privacy of one’s own home, there are inherent problems balancing out each of these promises. In this episode, we will review the pros and cons of at home testing for STIs and we will discuss why this is still caveat emptor, “buyer beware”, in this new healthcare marketplace option.

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